Session Agenda and Structure

About this resource

Session structure is one of the features that distinguishes CBT from less directive therapies, and it is rated as a core competence on the standard measures of CBT skill. A predictable structure keeps sessions focused on the client's priorities, ensures that homework is reviewed rather than forgotten, protects time for skill practice, and models the organised problem-solving that the therapy is trying to teach. Clients generally report that they value knowing what will happen in a session.

This resource describes the standard structure as set out in the Beck Institute tradition and gives a one-page template for planning and recording each session. The elements are: a brief mood check and update, a bridge from the previous session, collaborative agenda setting with priorities, review of between-session work, work on the agenda items, setting new between-session work, and a final summary with feedback from the client. Approximate time allocations are suggested for a fifty-minute session.

The professional version adds guidance on the common ways structure breaks down: agendas that are too long, sessions dominated by the week's events, homework review skipped when the homework was not done, and the final summary squeezed out. It also notes when to loosen the structure, for example in crisis sessions or with clients for whom the format feels controlling.

How to use it

1. Explain the structure to the client in the first session and ask for their reaction. Most clients appreciate it; a few find it rigid, and it is worth discussing why the structure helps before adapting it.
2. Begin each session with a brief mood check, using a measure where you have one, and a one-line update on the week. Keep this to a few minutes; the detail belongs in the agenda items.
3. Set the agenda together. Ask what the client wants to cover, add your own items, and agree priorities. Two or three items is usually the maximum for a fifty-minute session.
4. Always review the previous between-session work, whether it was done or not. If it was not done, treat that as the agenda item: what got in the way tells you something about the formulation.
5. Leave the final five to ten minutes for setting new homework, summarising the session, and asking the client for feedback on what was useful and anything that felt unhelpful or missed.
6. Use the template to plan before the session and to note what actually happened, so that drift in structure across a course of therapy becomes visible.

References

• Beck, J. S. (2020). Cognitive Behavior Therapy: Basics and Beyond (3rd ed.). Guilford Press.
• Blackburn, I. M., James, I. A., Milne, D. L., Baker, C., Standart, S., Garland, A., & Reichelt, F. K. (2001). The Revised Cognitive Therapy Scale (CTS-R): Psychometric properties. Behavioural and Cognitive Psychotherapy, 29(4), 431-446.
• Kennerley, H., Kirk, J., & Westbrook, D. (2016). An Introduction to Cognitive Behaviour Therapy: Skills and Applications (3rd ed.). SAGE.